Handout: Suicide Risk Assessment Checklist (49k PDF)

1. BDI Score: _______ Question 9 Response: ________

2. General Risk Factors:
history of psychiatric disorders: non-impulsive____ or impulsive____
family history of suicide
has a firearm in the home
history of previous suicide attempts: if yes, what method: ___________
depression
substance abuse
recent significant loss, such as death of a friend/spouse
anniversary of significant loss
stressful life event (separation, divorce, prison, or frequent relocation)
experienced violence (physical, sexual, domestic, or child abuse)
experienced poor parent-child communication
few social supports

3. Warning Signs:
withdrawl from others
drastic mood swings
marked personality changes
risky behavior
personal crisis
giving away possessions
beginning recovery

4. Assessing Lethality:
suicide threats
plan
means
opportunity